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Exam Proctoring Request Form
Instructor Name
First Name
 Last Name
Email
Student Name
First Name
 Last Name
Course Information
Course Title
 Course I.D.
Course Number
  
Exam Information
Exam Date
Ex. 01/01/07 		Exam Time
Ex. 9:00am
Exam Location
 
Exam Title
 Exam Type
In what format will the test be provided?
Paper
Disk
Online
Materials Allowed
Calculator
Notes
Book
Spell checker
Other Materials
Have you spoken with anyone from the Student Success Center?
Yes
No
If yes, can you please provide their name?
Please use the space below for testing directions
or any additional comments.
Instructors must bring a copy of the exam with test directions to Brennan 53 or email the exam with directions to lizardo@hnu.edu. The completed exam can be retrieved by the instructor from Brennan 53. If you have any other questions please call Alejandra Lizardo at ext. 1356.

Forms must be submitted 48 business hours prior to the desired test date. All late or incomplete forms will not be processed and the exam will not be administered. Instructors are expected to communicate and confirm with students both the test date and time before submitting an Exam Proctoring Request Form.
 
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